Our STRATEGIC OPEN ACCESS PLAN (SOAP) is designed to clean up your group medical program using common sense and traditional American business practices. Clients who adopt our strategies will realize plan savings of 20-40% while maintaining or even improving benefits at the same time.
“Cleaning up Your Employee Health Plan”
Still quoting the same 100/80/50 Dental Plans that were popular 20 years ago? Let’s surprise your client with a new and innovative dental offering.
Maybe the problem with solving health care in this country centers around the apparent abundance of naysayers………………
Judge, he’s a bully, manipulative, passive-aggressive and self-centered. I don’t love him anymore!
Continue reading Jilted Lover Wants Back Billion Dollar Engagement Ring
A Reference Based Pricing solution called SmartDecision. It offers RBP, bundled pricing, cost and quality information, and a concierge service to help members navigate the entire healthcare episode. Please review our flyer to learn more about this truly unique program. Click here to download.
Medicare-for-all would move every American onto one government insurer in two years, while providing everyone with medical, vision, dental and long-term care at no cost………….
Continue reading Attention Health Insurance Brokers: You’re One Election Away From Extinction
Anthem Antitrust Atty ‘Stunned’ At Cigna Balk On $54B Deal
A 25-year veteran antitrust lawyer for Anthem Inc. testified Tuesday he was stunned by Cigna Corp.’s sudden and allegedly fatal resistance to their now-abandoned, $54 billion tie-up, in the second day of a multibillion-dollar Delaware Chancery Court trial over the collapsed deal.
In Florida, Drug Re-Importation from Canada Finds New Champions, Old Snags
“Florida is joining the growing ranks of states that, squeezed by climbing drug prices, are eyeing the Canadian fix…. Legislation has been advanced this year in about a dozen states that would advance wholesale drug importation programs … While statehouses may be abuzz, in Washington, national politics impedes feasibility. And skeptics question how much relief these initiatives could actually provide.”
Kaiser Health News
“The specific questions include: [1] Do any of the requirements for maintaining grandfathered status create particular challenges, and how could these requirements be modified to reduce these challenges? [2] Why do plan sponsors choose to retain grandfathered status? [3] What are the costs and benefits that plan sponsors consider in deciding whether to retain grandfathered status? [4] Is preserving grandfathered status important to plan participants? [5] What changes in benefits typically trigger a loss of grandfathered status?”
Segal Consulting
Once upon a time, health benefits were just that – “benefits.” Now, it’s assumed health insurance is included in an employment package, and what was once a benefit is now an entitlement…..
Continue reading To RBP, or Not to RBP: That Is The Question
Mugshot photo of Melissa Welch-Latronica, 30, of LaPorte. (Porter County Sheriff’s Dept.)
Single mother goes from traffic stop to bench warrant to jail over unpaid medical bill: ‘It just isn’t right’
Price of Drugs Is Too Damn High!
“This ruling blows the insulin racket wide open,’’ said Steve Berman, a plaintiffs’ lawyer who is one of the leaders of the potential class-action case. The ruling “clears the way for us to begin obtaining discovery from the manufacturers and PBMs so we can shine the light on exactly what has driven insulin prices sky-high,’’ he said.
“Direct primary care (DCP) — a fee-based model that gives individuals unlimited access to a primary care doctor for anywhere between $60 to $150 a month, without insurance being billed — is the “future of healthcare….”
Continue reading Primary Care – The Future of Employee Care?
Last month, we received our license to sell Association Health Plans (AHPs) to medical groups in Texas through the Oklahoma State Medical Association (OSMA). They have a proven track record of providing significant savings to their members and offer a broad range of health plans.
Industry wide, transparency is not the standard. ProPublica sent a list of questions to 10 of the largest broker agencies, some worth $1 billion or more, including Marsh & McLennan, Aon and Willis Towers Watson, asking if they took bonuses and commissions from insurance companies, and whether they disclosed them to their clients. Four firms declined to answer; the others never responded despite repeated requests.
Continue reading Insurers Hand Out Cash and Gifts To Sway Brokers Who Sell Employer Health Plans
Brian Klepper
“Renegade PCPs long for independent practices where their patient care decisions are not so influenced by their employers’ interests……………….By recapturing control of care and cost, they also are re-establishing primary care’s primacy within health care……………..”
Continue reading TO UNDERSTAND VALUE’S MARKET PROGRESS, WATCH PRIMARY CARE
“In 60 seconds, this CEO explains why healthcare has blocked many manufacturing jobs from coming back to the U.S.” – Dave Chase on Linkedin………………..
The state of North Carolina has adopted Reference Based Pricing for their state employee benefit program to become effective in 2020. The reference price will be pegged at 177% of Medicare. That has caused an uproar with the state’s hospitals and they are fighting back hard.
Continue reading How Dare You! 177% of Medicare Is Insulting!
By Molly Mulebriar
McAllen Independent School District in deep South Texas is set to interview the top three finalist for the district’s insurance consultant position this week. MISD employee benefit program is self-insured and administered by Blue Cross & Blue Shield.
Continue reading McAllen ISD To Interview Top 3 Consultant Finalists
“It’s an intriguing way to lower costs for both physicians and health plans, and it could reduce premiums for patients. It also could enable doctors to wrestle more contract-negotiating leverage out of the hands of the market’s dominant health plans ― and in some cases, contracting with them might not even be necessary.”
Continue reading Texas Medical Association Highlights Reference Based Pricing
“We are taking that wasted money and artificially inflating the cost of health care to the point that nobody can afford it without government continuing the death spiral of spending, monopolizing, and price inflation.”
Continue reading American Health Care – The Economic Trojan Horse of Destruction
In this video, Dr. Eric Bricker Explains Reference-Based Pricing.
Dr. Eric Bricker Explains 3 Reasons for Having a PCP: 1) Screening, 2) Same-Day / Next-Day Appointments and 3) After-Hours Call-In Access.
Continue reading Reasons For Having A Primary Care Physician
In contrast to deductibles, where the patient pays the “first dollar” of medical expenses, under RBP, the patient is responsible for the “last dollar.”
Continue reading Why Aren’t More Employers Implementing Reference-Based Pricing Benefit Design?
Liberty Mutual has agreed to pay the Diocese of Duluth US$6.5 million under a recent settlement agreement over litigation of insurance coverage for child sexual abuse damages………..
Continue reading Catholic Diocese Insured Against Child Sexual Abuse Claims
Greenlight Re Innovations, part of specialist property and casualty insurer Greenlight Capital Re, has announced an investment in Sana Benefits, a Texas-based third-party administrator (TPA) focused on the self-insured health market……………...
Four men and seven companies have been charged in connection with a $1 billion healthcare scam, according to the Department of Justice………………….
AccuRisk Solutions LLC is a Chicago-based Managing General Underwriter focused on providing its producers with innovative insurance products and outstanding customer service.
“It’s cheaper for us to pay for the drug down there, send them down there and then give them $500….”
Japan Post would like to expand Aflac’s cancer insurance products sold at post office counters…..
Continue reading Japan Post Eyes $2.6 Billion Investment in AFLAC
Kratom is a miracle cure for everything from opioid addiction to anxiety……..
I’ve been asked many times if there was one thing, one moment, that led me to leave my job at a big health insurance corporation. Yes, there was, and it occurred five days before Christmas in 2007. That was when a beautiful 17-year-old girl named Nataline Sarkisyan passed away, days after the company I worked for refused to pay for a liver transplant that her doctors believed would save her life. A few days after Nataline’s death, I turned in my notice.
Continue reading Nataline Could Have Been 28 Today If Not For A Health Insurance Decision
If your’re in HR and believe in climate change this article is for you. You may want to consider offering your employees energy-free light bulbs and mandate car pooling………….
Continue reading Climate Change & Employee Benefits – Are You Kidding Me!
Molly Fetzer
Self-funded school district overrides TPA’s (Anthem) decision to deny coverage and authorizes doctor ordered treatment plan for stage 4 cancer member………………….
“I’m 67, so I could give a shit,” she says. “What are they going to do, fire me? I’m packin’ a Medicare card.” – Marilyn Bartlett
Colorado on Thursday joined a growing number of states that want to cut certain prescription drug prices by importing licensed drugs from Canada………………..
Bernie Discovers Self At Early Age
Senator Sanders asks why drug, once free, now costs $375,000,000.00…………..
The HRA’s Are Coming!
Expands the use of HRAs to allow for the purchase of individual health insurance coverage…..
Hawaii considers ban on cigarette sales except for centenarians…………………..
Health insurer’s purchase of Express Scripts is looking like even more of a blunder……..
With steady growth in the last four decades, self-funded plans are now the most common type of health plan that workers are enrolled in across the United States. Various sources put this number at nearly 70% and climbing. Nearly all self-funded employee benefit plans are managed through a third party administrator (TPA) firm, an independent organization that assists with overall plan operations, benefit coordination and claims processing.
Continue reading The Prevalence of Self-Funded Health & Welfare Plans
